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Category: Politics

Ensuring that the 21st Century Cures Act Health IT Provisions Promotes Interoperability and Data Exchange

By KENNETH D. MANDL, MD; DAN GOTTLIEB;
JOSH C. MANDEL, MD

Josh Mandel

Kenneth Mandl

Dan Gottlieb

The opportunity has never been greater to, at long last, develop a flourishing health information economy based on apps which have full access to health system data–for both patients and populations–and liquid data that travels to where it is needed for care, management and population and public health. A provision in the 21st Century Cures Act could transform how patients and providers use health information technology. The 2016 law requires that certified health information technology products have an application programming interface (API) that allows health information to be accessed, exchanged, and used “without special effort” and that provides “access to all data elements of a patient’s electronic health record to the extent permissible under applicable privacy laws.”

After nearly two years of regulatory work, an important rule on this issue is now pending at the Office of Management and Budget (OMB), typically a late stop before a proposed rule is issued for public comment. It is our hope that this rule will contain provisions to create capabilities for patients to obtain complete copies of their EHR data and for providers and patients to easily integrate apps (web, iOS and Android) with EHRs and other clinical systems.

Modern software systems use APIs to interact with each other and exchange data. APIs are fundamental to software made familiar to all consumers by Google, Apple, Microsoft, Facebook, and Amazon. APIs could also offer turnkey access to population health data in a standard format, and interoperable approaches to exchange and aggregate data across sites of care.

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Please support Charles Gaba at ACASignups

By CHARLES GABA

It’s pretty rare that I ask THCB readers to go over to another blog and support that blog with money BUT, today is the day to do that. Charles Gaba has been THE leading source of information about exactly who is signing up for ACA plans on which exchange, and what impact on the ACA Trump et al have had. He’s not in academia, not on some big company or foundation payroll, just a one man band web designer who has basically torpedoed his own business to deliver what I think is a vital service. I support him and anyone interested in health policy could do a lot worse than shove a few bucks a year his way. Read on for his story & how you can helpMatthew Holt

On October 11th, 2013, I posted the following in a blog entry over at Daily Kos, where I’d been a regular contributor since 2003:

“Seriously, though, HHS should really start releasing the official (accurate) numbers of actual signups for all 50 states (or at the very least, the 36 states that they’re responsible for) on a daily–or at least, weekly–basis. I don’t care if it’s a pitifully small number. 100,000? 10,000? 100? 10? Even if it’s in single digits, release the damned numbers. Be upfront about it. Everyone knows by now how f***** up the website is, so be honest and just give out the accurate numbers as they come in.”

Two days later, on October 13th, I registered “ObamacareSignups.net” (which soon changed to ACASignups.net, not because I had a problem with “Obamacare” but because it was easier to type) and posted an announcement over at dKos, asking for some crowdsourcing assistance.

This was supposed to be just a lark…a six-month thing which would combine my passion for data analysis, politics and website development into one nerdy hobby.

Instead…well, if you’ve been following my work for any length of time, you know the rest of the story. ACASignups.net soon caught the attention of major media outlets, and it’s been cited and used as a resource ever since by media outlets spanning the ideological spectrum including the Washington Post, Forbes, Bloomberg News, Vox.com, MSNBC, the New Republic, USA Today, the CATO Institute, National Review Online and The New York Times among others, and has even received a mention (albeit an obscure one) in prominent medical journals such as the New England Journal of Medicine and The Lancet.

For awhile I pretended that this was still a “hobby”…I accepted donations, sure, and even slapped some banner ads on the site to drum up a few bucks, but in my mind, I was still officially a website developer…even though I was spending 90% of my time posting updates here instead of maintaining my business. In April 2014, at the peak of the media attention and insanity over the crazy first open enrollment period, I even came down with a nasty case of shingles whch laid me up for over a month. I was in denial for years even as the business suffered, constantly thinking that as soon as this Open Enrollment Period was over, I’d wrap things up…

My ass was effectively saved by Markos and the Daily Kos community that year, who collectively raised enough money to not only make up for my lost business in 2014, but also to allow me to keep the site operating through 2015 as well. I’m eternally grateful for that support.

In the fall of 2016, things came to a head and I realized that I could no longer continue living with one foot in each world: I had to either mothball this site and refocus my efforts on building my web development business back up…or I had to try and earn a living at it.

At the time–and I swear on my life this is true–I was planning on doing the former. My reasoning was simple: If Hillary Clinton had become President, there probably wouldn’t be that much interest in my work here going forward. There’d still be plenty of healthcare stuff to write about, but the ACA would be safely embedded into the American landscape and interest in the day to day minutiae of its developments would fade over time.Continue reading…

Does Free Medical School Decrease Social Justice?

BY ANISH KOKA, MD

The hottest medical school in the country right now is the New York University School of Medicine thanks to the gift of a generous benefactor that promises to make medical school free for all current and future medical students.  The news was met with elation from the medical community of physicians that groans frequently about student debt loads routinely north of $200,000 upon matriculation.  Not surprisingly, the technocrat class of public health experts and economists did not share in the jubilation.  The smarter-than-the-rest-of-us empiricists are, after all, trained to think in terms of social justice and net benefits to society.   The needs of medical students are far down the list of priorities when forming this social justice utopia.

Contemporary arguments for social justice in some form or the other trace their roots to the philosopher John Rawls and his 1971 magnum opus – “A Theory of Justice”.  In words that would infuse liberal thought for a generation, Rawls laid out a blueprint for a just society by proposing a thought experiment called “the original position”.  This was a hypothetical scenario where a group of people are asked to form the rules of a society which they will then occupy. The catch is that the people making the decision do so behind a ‘veil of ignorance’ not knowing the disadvantages conferred by any number of attributes (age, sex, gender, intelligence, beauty, etc. ) they may be reincarnated with. Rawls posited that under conditions in which there was a possibility of being born as a disadvantaged member of society, social and economic inequalities would be arranged to be of greatest benefit to the least advantaged members of society.

At first glance, it would seem that the objections to tuition-free medical school rest on a social justice framework that does not seem to comport with gifts to the soon-to-be-wealthy.  After all, the $200,000 investment for medical school pales in comparison to the lifetime earnings of the average physician who is assured at least a six-figure income in seeming perpetuity. But it is not entirely clear that one has to even combat Rawlsian ideals to rebut the social justice do-gooders with strong opinions on how other people should spend their money.  A Rawlsian framework never intended that everyone in society would be able to achieve the same outcome regardless of starting position.  Rawls actually went out of his way to argue that inequalities were justified in society as long as the operating rules served to raise the position of those worst off in society.  A rising tide should lift all boats – the rich may become richer, as long as the poor become richer as well.

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A Cross-Party Win: Empowering Consumers Through Digital Health

By LYGEIA RICCIARDI

Lygeia Ricciardi

These days Americans are more politically divided than ever, disagreeing vehemently about everything from guns to the role of the press. Despite the distrust and inflammatory rhetoric, there are examples of cross-party, trans-Administration collaboration and success. Let’s celebrate them and be motivated by what happens we put differences aside and focus on shared long-term goals.

Using digital technology to empower healthcare consumers is one example of a cross-party win, a still-developing success story that has been cultivated for more than a decade by the efforts of public and private sector leaders from a wide variety of affiliations and political perspectives.

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